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Idiopathic Scoliosis

By Frank Pessler, MD, PhD, Helmholtz Centre for Infection Research;Hannover Medical School, Braunschweig, Germany;Hannover, Germany

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Idiopathic scoliosis is lateral curvature of the spine.

Idiopathic scoliosis is the most common form of scoliosis and is present in 2 to 4% of children aged 10 to 16 yr. Boys and girls are equally affected; however, it is 10 times more likely to progress and require treatment in girls.

Genetic factors contribute about one third of the risk of disease development. Mutations in the CHD7 and MATN1 genes have been implicated in some cases.

Symptoms and Signs

Scoliosis may first be suspected when one shoulder seems higher than the other or when clothes do not hang straight, but it is often detected during routine physical examination. Other findings include apparent leg-length discrepancy and asymmetry of the chest wall. Patients may initially report fatigue in the lumbar region after prolonged sitting or standing. Muscular backaches in areas of strain (eg, in the lumbosacral angle) may follow.


  • X-ray of the spine

The curve is most pronounced when patients bend forward. Most curves are convex to the right in the thoracic area and to the left in the lumbar area, so that the right shoulder is higher than the left. X-ray examination should include standing anteroposterior and lateral views of the spine.

The greater the curve, the greater the likelihood that it will progress after the skeleton matures. Curves > 10° are considered significant. Prognosis depends on site and severity of the curve and age at symptom onset. Significant intervention is required in < 10% of patients.


  • Physical therapy and bracing

  • Sometimes surgery

Prompt referral to an orthopedist is indicated when progression is of concern or the curve is significant. Likelihood of progression is greatest around puberty. Moderate curves (20 to 40°) are treated conservatively (eg, physical therapy and bracing) to prevent further deformity.

Severe curves (> 40°) may be ameliorated surgically (eg, spinal fusion with rod placement).

Scoliosis and its treatment often interfere with an adolescent’s self-image and self-esteem. Counseling or psychotherapy may be needed.

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